ABC | Volume 113, Nº2, August 2019

Original Article High Level of Lipoprotein(a) as Predictor for Recurrent Heart Failure in Patients with Chronic Heart Failure: a Cohort Study Jianlong Yan, 1 * Yanbin Pan, 2* Junhui Xiao, 1 Wenxue Ma, 1 Li Li, 1 Mingjiang Zhong, 1 Haiquan Long, 1 Fanliang Kong, 1 Wenming Shao 3 Huadu District People's Hospital, Southern Medical University – Cardiology, 1 Guangzhou – China Huadu District People's Hospital, Southern Medical University - Intensive Care Unit., 2 Guangzhou – China The First Affiliated Hospital of Jinan University – Emergency, 3 Guangzhou – China * Jianlong Yan and Yanbin Pan were co-first authors, they contributed equally to this study. Mailing Address: Junhui Xiao • Huadu District People’s Hospital, Southern Medical University, 48 Xinhua Road, Huadu, Guangzhou, Guangdong, 510800 - China E-mail: xiaojunhui2009@hotmail.com Manuscript received September 18, 2018, revised manuscript November 03, 2018, accepted November 14, 2018 DOI: 10.5935/abc.20190120 Abstract Background: Elevated plasma levels of Lipoprotein(a) [Lp(a)] are recognized as a significant risk factor for atherosclerotic vascular disease. However, there are limited data regarding association between Lp(a) and recurrent heart failure (HF) in patients with chronic HF caused by coronary heart disease (CHD). Objective: Elevated levels of Lp(a) might have a prognostic impact on recurrent HF in patients with chronic HF caused by CHD. Methods: A total of 309 patients with chronic HF caused by CHD were consecutively enrolled in this study. The patients were divided into 2 groups according to whether Lp(a) levels were above or below the median level for the entire cohort (20.6 mg/dL): the high Lp(a) group (n = 155) and the low Lp(a) group (n = 154). A 2-sided p < 0.05 was statistically considered significant. Results: During the median follow-up period of 186 days, 31 cases out of a total of 309 patients (10.03%) could not be reached during follow-up. A Kaplan–Meier analysis demonstrated that patients with higher Lp(a) levels had a higher incidence of recurrent HF than those with lower Lp(a) levels (log-rank < 0.0001). A multivariate Cox regression analysis revealed that Lp(a) levels were independently correlated with the incidence of recurrent HF after adjustment of potential confounders (hazard ratio: 2.720, 95 % confidence interval: 1.730-4.277, p < 0.0001). Conclusions: In Chinese patients with chronic HF caused by CHD, elevated levels of Lp(a) are independently associated with recurrent HF. (Arq Bras Cardiol. 2019; 113(2):197-204) Keywords: Lipoproteins; Apolipoproteins; Heart Failure; Coronary Artery Disease; Hypertension; Diabetes Mellitus; Echocardiography/methods; Cohort Studies. Introduction Heart failure (HF) is a global, severe public health issue. 1 According to previous reports, the prevalence of HF is stable, at approximately 1% to 2% of the general population, but this number sharply increases to 20% in those aged over 80 years. 2 Among most developed and developing countries, the increasing number of HF patients has already become a significant epidemic and a major cause of hospitalizations, morbidity, and mortality despite advances in the treatment of HF. 3-6 Elevated plasma levels of Lipoprotein(a) [Lp(a)] are recognized as a significant risk factor for atherosclerotic cardiac and cerebrovascular disease. 7-11 Lp(a) consists of one molecule of a low density lipoprotein (LDL)-like particle, containing apolipoprotein B-100 (apoB) and one molecule of a large highly polymorphic glycoprotein, named apolipoprotein(a) (apoA), which are connected by a single disulfide bond. 12 Studies have shown that Lp(a) contributes to cardiovascular disease (CVD) risk through multiple mechanisms, such as proatherogenic, proinflammatory, and potentially antifibrinolytic mechanisms. 13-15 In the current studies, high levels of Lp(a) have been shown to be an independent risk factor for myocardial infarction, 8 stroke, 7 aortic stenosis, 16 and, as now shown, HF. 17 However, no studies have illustrated the significant association between Lp(a) levels and recurrent HF in participants with chronic HF caused by coronary heart disease (CHD). Therefore, our study sought to evaluate the association between plasma levels of Lp(a) and recurrent HF in patients with chronic HF caused by CHD. Methods Research design and population In total, 309 hospitalized patients who were diagnosed with chronic HF due to CHD in the First Affiliated Hospital of Jinan University Guangzhou, China, were consecutively 197